MRCP is well establised as an entry exam for advanced specialist training in many countries including Malaysia. It consists of 3 paper i.e. Part1, Part2(written tests) and PACES.
PACES in full means Practical Assessment of Clinical Examination Skills. It is the third part and the candidate is assessed by fellows of RCP.
I passed my PACES in 2005. I am glad that many seniors had guided me throughout my preparation for PACES and I wish to share my experiences with PACES candidates via this blog.

Wednesday, June 13, 2007

Respiratory Quiz

During yesterday’s MRCP mock exam, Wuchereria had a tough time with one of the local examiner.

This patient has clubbing with cyanosis and bilateral fine crepitations over the bases with a scar as seen in the picture. He also has an area of consolidation over the R lower zone

he might have an infarct which leeds to ruptured septum causing VSD after few years he dev eisenmenger syndrome due to right to left shunt causing cyanosis and finger cubbing. he is currently in failure as evidence by bibasal creps with superimposed pneumonia at right lower lobe.

Yes, the incidence of AF after any cardiac surgery is between 10%-50%.

Although a AV nodal blocking agent is generally preferred (class I) as the 1st line for AF after cardiac surgery, some patients might not be able to tolerate one. Hence amiodarone (class IIa) is used in these patients.

Firstly, we have to know the age of the patient. In Respi station- young patient with clubbing, cyanosis and lung operation means CF unless proven otherwise.CABG with amiodarone induced lung injury wont have clubbing and cyanosis.Clubbing, cyanosis, sternotomy scar will be congenital heart disease with amiodarone induced fibrosis causing crackles.

clubbing,cyanosis in a respiratory station is either fibrosing alveolitis, suppurative lung disease or ca lung the pt has ca lung leading to consilidation and the ischaemic heart disease is coincidence.

Since when is rythm control better than rate control for AFib? Amiodarone may be used for post-cardiac surgery for rythm control but not for long periods. It is usually taken off, specially in young patients because of its s/e profile & if AFib persists it is managed with beta-blockers & anticoagulation.

Why would a young patient have CABG surgery??? Even if he is a heavy smoker & diabetic, CAD takes time to develop. More likely, he has underlying congenital heart disease.

this is a resp station, so simply amidarone induced lung fibrosis due to cyanotic heart disease or CABG or remotley heartlung transplantation with bronchioltiis obliterans..(lower zone consolidation)that's it!